Fortunately neither Bill nor I have to take any prescription drugs. Oh sure, there have been the rare times when we’ve needed a doctor’s signature for a painkiller or an antibiotic but nothing long term. During pollen season, however, I do take an over-the-counter antihistamine that was available in the US in a bottle of 365 tablets while here it comes in boxes of 7. That does mean a frequent visit to the pharmacy but we’re always out walking anyway so another stop is no problem. On our most recent outing we discovered that the shelf where these generic boxes were typically stocked by the hundreds was almost empty because the manufacturer was switching from pills to a liquid format in banana flavor that would be double the price we were paying. Time to investigate getting a prescription from our family doctor that would at least have the advantage of being partially reimbursable by the national health system.
Given that a box of 7 cetirizine tablets used to cost only 1€, it didn’t seem worth paying for a doctor’s appointment for him to write an ordonnance for a 90-day supply. But now it was reasonable to find out what that might cost. We already knew that a visit to the doctor results in an out-of-pocket charge of 7.50€; that is, we pay the doctor 25€ and within 4 days we’re reimbursed 16.50€ by the national health insurance system. To find out the price of a prescription for any medication you can consult the government’s database Base De Données Publique des Médicaments at https://base-donnees-publique.medicaments.gouv.fr/. Here you will find the highest authorized amount that a pharmacy can charge for the drug itself and a fee for dispensing it. It also shows what rate of reimbursement, from 15% to 100%, that you will receive from the government.
To show how this works, I looked at the website ClinCalc where they listed the top 300 prescribed drugs in the US, most recently for 2019. Here are some examples if you purchased those prescriptions in France:
|Drug name||Highest base price €||Highest dispensing fee €||Total before reimburse-ment €||Rate of reimburse-ment|
|Atorvastatin, 10 mg, 30 tablets||4.19||1.02||5.21||65%|
|Lisinopril, 20 mg, 28 tablets||3.52||1.02||4.54||65%|
|Metformin, 1000 mg, 30 tablets||2.06||1.02||3.08||65%|
The rate of reimbursement is based on the government’s assessment of how effective a medication is. From what I read, 65% is the most common rate indicating a major impact while the cetirizine that I was taking is considered only moderately effective and if prescribed receives a rate of 30%. Over-the-counter medications are not reimbursed and pharmacists are free to set their own prices for these products. Note: although it is called a “reimbursement” in our experience the pharmacy only charges the patient the lower net amount and bills the national health insurance system for the difference.
Although there is a maximum price for each medication, pharmacies might charge less than the full amount in what we believe to be a competitive business. After all, we walk by at least 4 other pharmacies on our 18-minute walk to where we typically shop. In fact, we may be visiting all of those soon to compare prices on their antihistamines now that I’ve consulted the database mentioned above. The maximum price for a prescription of 15 cetirizine tablets is 3.24€ minus a 30% reimbursement of .97€ leaving 2.27€ which is almost exactly what we recently paid for one of those over-the-counter boxes of 7. Hello Doctor, I need a prescription, please!
Photo note: The featured photo at the top is in the city of Tours during the springtime at the start of pollen season.